Per 42 CFR §441.304(f) public input must be sufficient in light of the scope of the changes proposed. The state must share with the public the entire waiver. State must provide at least two (2) statements of public notice and public input procedures, with one being web-based. The state must provide at least a 30 day public notice and comment period, which must be completed at a minimum of 30 days prior to submission of the proposed change to CMS.

Target Groups:

Aged or disabled

Intellectually disabled or developmentally disabled

Mentally ill (under age 22-or over age 64)

Any subgroup of the above

May service multiple target groups within one 1915(c) waiver

Other Unique Requirements:

May serve multiple target groups within one waiver program and/or have multiple waivers.

Cannot cover:

Room & board costs except for allowable transition services.

Special education and related services provided under IDEA that are education related only & vocational services provided under Rehab Act of 1973.

Required if participant direction is offered. May be a waiver service, an administrative function, or performed directly by the SSMA.

Employer Status for Participant Direction:

Participant may be the employer of record under a Fiscal/Employer Agent model or the entity may be the employer of record under an Agency with Choice model

Goods and Services:

Permitted as a wavier service.

Direct Payment of Providers:

Required. State may use alternative voluntary option of an Organized Health Care delivery System to make payments.

Exception allowed under §447.10 Prohibition against reassignment of provider claims:

§447.10(g)(4): In the case of a class of practitioners for which the Medicaid program is the primary source of service revenue, payment may be made to a third party on behalf of the individual practitioner for benefits such as health insurance, skills training and other benefits customary for employees.

Provider Payments:

Payment item must be listed in the service plan (plan of care), provided by an enrolled provider, and provided prior to reimbursement.

Cost Requirements:

Must be cost-effective.

Average annual cost per person served under §1915(c) cannot exceed average annual cost of institutional care for each target group served.

Quality Management:

Extensive quality management and quality improvement activities required per the HCBS Waiver Application, including how state will comply with all waiver assurances and how state will conduct quality oversight, monitoring and discovery, remediation, and improvement of issues relating to quality.

Interaction with State Plan Services, Waivers & Amendments:

Participants have access to and must utilize state plan services before using identical extended state plan services under the waiver.

Waiver services may not duplicate state plan services.

Individuals may be eligible for and receive State plan, §1915(c), §1915(i), §1915(j)/§1915(k) services simultaneously.